The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for sexually transmitted infections, HIV and viral hepatitis in ...
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The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for sexually transmitted infections, HIV and viral hepatitis in England Provisional data: January to September 2020 1
The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for
sexually transmitted infections, HIV and viral hepatitis in England
Contents
Summary...................................................................................................................................... 3
Introduction .................................................................................................................................. 4
Data reporting and presentation in this report .......................................................................... 4
Service Provision ......................................................................................................................... 5
Trends in consultations undertaken by SHSs and specialised HIV services ............................ 5
Vaccine provision for MSM at SHSs ......................................................................................... 8
HIV post-exposure prophylaxis in SHSs ................................................................................. 10
Testing for STIs, HIV and Hepatitis ........................................................................................ 11
Diagnoses and proportion of people tested that are positive ..................................................... 19
HIV and STI diagnoses and positivity ..................................................................................... 19
Hepatitis diagnoses and positivity .......................................................................................... 23
Treatment and care .................................................................................................................... 29
Evidence from service user and community surveys ................................................................. 30
People who inject drugs ......................................................................................................... 30
Men who have sex with men .................................................................................................. 30
Discussion.................................................................................................................................. 31
Impact on health inequalities .................................................................................................. 32
Mitigations to address the impact of COVID-19 ...................................................................... 32
Future work ............................................................................................................................ 34
Key messages to communicate to patients and service users ................................................... 34
Appendix .................................................................................................................................... 36
References................................................................................................................................. 36
2The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for
sexually transmitted infections, HIV and viral hepatitis in England
Summary
PHE has undertaken analyses to assess the impact of the COVID-19 pandemic
response on sexually transmitted infection (STI), HIV and viral hepatitis service provision
and epidemiology.
Between March and May 2020, there was a reduction in:
• consultations undertaken by sexual health services (SHSs) and specialised HIV
services
• testing for viral hepatitis in drug services, prisons, general practice and SHSs
• testing for HIV and STIs in SHSs
• vaccination of gay, bisexual and other men who have sex with men (MSM) against
Human Papillomavirus (HPV), hepatitis B (HBV) and hepatitis A (HAV)
• diagnoses of viral hepatitis, HIV and STIs
• and hepatitis C (HCV) treatment initiations
A resurgence in HIV, STIs and hepatitis tests and diagnoses, and an increase in
hepatitis C virus (HCV) treatment initiations, were observed from June 2020, following
the easing of national lockdown restrictions. This reflects a partial recovery in service
provision and demand. Nevertheless, numbers of consultations, vaccinations, tests,
diagnoses, and treatment initiations in the summer of 2020 were considerably lower than
in corresponding months in 2019.
Innovation in service delivery such as online or tele-consultations for HIV and hepatitis,
STI and blood-borne virus (BBV) self-sampling kits, and expanded community outreach
testing and linkage to care for HCV, has happened at pace during 2020. While this has
enabled access to services during the COVID-19 response, there is a critical need to
evaluate the impact of these changes on health inequalities, as HCV, HIV and many
STIs predominantly affect socially disadvantaged and/or marginalised groups who
already experience poor health outcomes, including people who inject drugs (PWID) and
experience homelessness, and certain black and Asian ethnic minorities. Of particular
concern, HCV testing through traditional venues may not have reached those in greatest
need and, while HIV and STI testing was accessed by those with high likelihood of
infection, some population groups were under-represented. PHE has worked
collaboratively with partner agencies to develop a suite of resources to support service
provision and equitable access during the pandemic response. These resources are
available on the Sexual Health, Reproductive Health and HIV K-Hub, the British
Association for Sexual Health and HIV (BASHH) website and The Faculty of Sexual and
Reproductive Health (FSRH) website.
These early findings indicate that the COVID-19 pandemic response, including social
and physical distancing measures, has led to a re-prioritisation and disruption in
3The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for
sexually transmitted infections, HIV and viral hepatitis in England
provision of, and patient access to, health services for HIV, STIs and viral hepatitis.
Reduced demand for services during this time may have been influenced by compliance
with social distancing measures as well as changes in risk perception and behaviour.
The full impact on infection transmission and long term health outcomes will take time to
emerge and evaluate.
Introduction
In response to the COVID-19 pandemic, in March 2020 the UK Government took steps
to reduce transmission of SARS-CoV-2 (the virus which causes COVID-19) through the
introduction of social and physical distancing measures. These measures and the
redeployment of health staff to the pandemic response led to a reduction or
reconfiguration of clinical services providing care for STIs, HIV and viral hepatitis. The
Association of Directors of Public Health published recommendations on the
prioritisation of sexual and reproductive health services in April. Similarly, calls for
sustaining drug and alcohol services - essential providers of harm reduction and BBV
testing for key risk groups - were made by the European Monitoring Centre for Drugs
and Drug Addiction (EMCDDA) and PHE.
This report presents the results of analyses of national surveillance data to assess the
impact of the COVID-19 pandemic to-date on STI, HIV and viral hepatitis service
provision and epidemiology. Provisional data are presented up to June, August or
September 2020, depending on the data source, recognising that at this time there is
likely to be under reporting and delayed data submission for the most recent months due
to the pandemic.
Data reporting and presentation in this report
Data for STIs and HIV (including consultations and vaccine provision) are compiled
using STI surveillance data submitted by SHSs, HIV specialised services and for
chlamydia only, tests and diagnoses submitted by laboratories [i]. At the time of writing
this report, STI surveillance data were available for 86% of SHSs for January to March
2020, and 66% for April to June. Data on HIV outpatient care consultations were
available from 56% of HIV specialised services from January to September 2020.
i Data from specialist (Level 3) and non-specialist (Level 2) are based on SHSs' returns to the GUMCAD STI
Surveillance System; further details on the levels of sexual healthcare provision are provided in the Appendix and in
the BASHH Standards for the Management of STIs (Appendix B). Data from HIV specialised services are based on
reports to the HIV and AIDS Reporting System (HARS). Data on all chlamydia tests from local authority (LA) and
National Health Service (NHS) commissioned laboratories are submitted to the Chlamydia CTAD Surveillance
System.
4The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for
sexually transmitted infections, HIV and viral hepatitis in England
Similarly, chlamydia testing data were available for 89% of laboratories between January
and June 2020. Further details are provided in the Appendix.
Missing data submissions will affect reported trends in service provision and outcomes.
Therefore, data presented in this report compare figures from SHSs, HIV specialised
services and chlamydia testing laboratories with complete data reported for both
January to June/September 2019 and January to June/September 2020 to assess the
impact of the COVID-19 pandemic response. Total figures from SHSs, HIV specialised
services and laboratories for 2019 are presented to illustrate the extent of under-
reporting.
Data for viral hepatitis come from various settings along the care pathway as prevention,
testing, diagnosis and treatment are commissioned and provided by multiple
organisations. Diagnoses are based on laboratories reporting to the Second Generation
Surveillance System (SGSS). As SGSS de-duplicates to provide new diagnoses only
from laboratories and does not provide the denominator, the relative contribution to the
decline in reporting laboratories from under-reporting versus a true reduction in new
diagnoses cannot be disentangled.
Service Provision
Trends in consultations undertaken by SHSs and
specialised HIV services
Between January and June 2020, comparing data from SHSs with complete data
reported for both January to June in 2019 and January to June in 2020, there was a
13% reduction in consultations at SHSs in England (including face to face and internet
delivered consultations) compared to the same period in 2019 (Figure 1). There was a
downward trend from January to April 2020, followed by a recovery in May and June,
however, the number of consultations reported in June 2020 was 11% lower than in
June 2019.
Most consultations undertaken by SHSs are in person, but there has been a two-fold
increase in internet consultations since April 2020. Between January and March 2020,
approximately 26% of consultations were delivered via the internet each month,
compared to 45% in April, 46% in May, and 41% in June.
5The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for
sexually transmitted infections, HIV and viral hepatitis in England
Figure 1: Number of consultations undertaken by sexual health services in
England and proportion of internet consultations, January 2019 to June 2020
2019 2020
2019 (all SHS) % Internet consultations 2019
% Internet consultations 2020
400,000 100%
350,000 90%
Percentage of consultations
Number of constulations
80%
300,000
70%
250,000 60%
200,000 50%
150,000 40%
30%
100,000
20%
50,000 10%
0 0%
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Month
The bars compare data from SHSs which had complete data reported for both January to June in 2019 and January
to June in 2020. The dotted line represents the total number of consultations reported in each month in 2019.
Trends in the number of consultations were similar across different age groups, gender
and sexual risk groups, ethnic groups and deprivation levels (measured using the Index
of Multiple Deprivation (IMD) quintile of residence [ii]). However, between April and June
2020, a slightly lower proportion of consultations undertaken by SHSs were among
people aged 15 to 19 (10% vs 12%) and 45 to 64 years (8% vs 10%) and a higher
proportion were among people aged 25 to 34 (39% vs 36%) and 20 to 24 years (27% vs
26%), than in January to March 2020 (Appendix Figures 1 to 5). Over the same period, a
lower proportion of consultations were among heterosexuals (men 23% vs 25%; women
61% vs 62%), and a higher proportion were among MSM (15% vs 12%).
ii Index of Multiple Deprivation (IMD) is an overall measure of relative deprivation that combines information on seven
domains of deprivation: 1) income 2) employment 3) health, skills and training, 4) crime 5) barriers to housing and
services 6) health and disability and 7) living environment. IMD quintile is generated based on the Lower Level Super
Output Area (LSOA) of Residence (small geographic areas designed to have a population size of between 1500 and
3000).
6The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for
sexually transmitted infections, HIV and viral hepatitis in England
Figure 2: Number of consultations at sites providing HIV outpatient care in
England by consultation medium, January 2019 to September 2020
Face to face (2019) Telephone (2019) Other (2019)
Face to face (2020) Telephone (2020) Other (2020)
All clinics (2019)
30,000
Number of Consultations
25,000
20,000
15,000
10,000
5,000
0
2019
2020
2019
2020
2019
2020
2019
2020
2019
2020
2019
2020
2019
2020
2019
2020
2019
2020
2019
2020
2019
2020
2019
2020
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Month and year
The bars compare data from specialised HIV services which had complete data reported for both January to
September in 2019 and January to September in 2020. The symbols represent the total number of consultations
reported in each month in 2019.
Between January and September 2020, comparing data from specialised HIV services
with complete data reported for both January to September in 2019 and January to
September in 2020, there was an 8% reduction in consultations for HIV outpatient care
(including face to face and telephone consultations) compared to the same period in
2019 (Figure 2). There was a downward trend from March to May 2020, followed by a
recovery from June to September. There were 45% fewer consultations reported in May
2020 than in May 2019. Consultations in September 2020 were 25% higher than in
2019.
Between January and September 2019, 96% of all consultations for HIV outpatient care
were face to face. Between April and September 2020, face to face consultations
constituted 64% of all consultations, with telephone consultations and other forms
constituting 33% and 3% respectively.
7The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for
sexually transmitted infections, HIV and viral hepatitis in England
Vaccine provision for MSM at SHSs
Between January and June 2020, the total number of vaccinations [iii] (first dose)
administered to MSM for hepatitis A virus (HAV) was 54% lower, for hepatitis B virus
(HBV) 48% lower and for human papillomavirus virus (HPV) 60% lower, compared with
the same period in 2019 (Figures 3 to 5). Between January and April 2020, the number
of vaccinations administered fell steeply, with a slight increase reported during May and
June 2020. However, the number of vaccines delivered in June 2020 was markedly
lower than in June 2019 (≥80% lower for all vaccine types).
Figure 3: Number of first doses of Hepatitis A virus (HAV) vaccination among
MSM, January 2019 to June 2020
2019 2020 2019 (all SHS)
1,600
1,400
Number of vaccinations
1,200
1,000
800
600
400
200
0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Month
The bars compare data from SHSs which had complete data reported for both January to June in 2019 and January
to June in 2020. The dotted line represents the total number of first doses of HAV among MSM reported in each
month in 2019.
iii Data are based on the number of vaccinations recorded regardless of eligibility or vaccination history.
8The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for
sexually transmitted infections, HIV and viral hepatitis in England
Figure 4: Number of first doses of Hepatitis B virus (HBV) vaccination among
MSM, January 2019 to June 2020
2019 2020 2019 (all SHS)
1,600
1,400
Number of vaccinations
1,200
1,000
800
600
400
200
0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Month
The bars compare data from SHSs which had complete data reported for both January to June in 2019 and January
to June in 2020. The dotted line represents the total number of first doses of HBV vaccination among MSM reported in
each month in 2019.
Figure 5: Number of first doses of human papillomavirus (HPV) vaccination
among MSM, January 2019 to June 2020
2019 2020 2019 (all SHS)
4,000
3,500
Number of vaccinations
3,000
2,500
2,000
1,500
1,000
500
0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Month
The bars compare data from SHSs which had complete data reported for both January to June in 2019 and January
to June in 2020. The dotted line represents the total number of first doses of HPV among MSM reported in each
month 2019.
9The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for
sexually transmitted infections, HIV and viral hepatitis in England
HIV post-exposure prophylaxis in SHSs
HIV post-exposure prophylaxis following sexual exposure (PEPSE) is used to prevent
HIV infection. A 28-day course of antiretroviral therapy may be prescribed up to 72 hours
after sexual exposure where there is a high risk of HIV transmission, eg receptive
condomless sex with a partner of unknown HIV status and from a known risk-group [1].
Between January and June 2020, consultations where PEPSE was prescribed were
36% lower than in the same period in 2019 (Figure 6). Between January and April 2020,
the number of PEPSE prescriptions declined sharply, followed by a slight increase in
May and June 2020. The number of prescriptions in June 2020 was 39% lower than in
June 2019.
Figure 6: Number of consultations where HIV post-exposure prophylaxis following
sexual exposure (PEPSE) was prescribed at sexual health services in England,
January 2019 to June 2020
2019 2020 2019 (all SHS)
1,400
1,200
Number of consultations
1,000
800
600
400
200
0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Month
The bars compare data from SHSs which had complete data reported for both January to June in 2019 and January
to June in 2020. The dotted line represents the total number of consultations where PEPSE was prescribed reported
in each month in 2019.
10The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for
sexually transmitted infections, HIV and viral hepatitis in England
Testing for STIs, HIV and Hepatitis
Testing for STIs and HIV
Between January and June 2020, comparing data from SHSs and chlamydia testing
laboratories with complete data reported for both January to June in 2019 and January
to June in 2020, there was a 30% reduction in tests for chlamydia, gonorrhoea and
syphilis at SHSs compared to the same period in 2019 [iv] (excluding chlamydia tests in
the age group targeted by the National Chlamydia Screening Programme [NCSP] [v])
(Figure 7). Similarly for HIV, there was a 35% reduction in tests at SHSs (Figure 8).
As with consultations at SHSs, the number of bacterial STI and HIV tests in SHSs
declined sharply between January and April 2020, by 71% for STIs and 77% for HIV.
There was a modest increase in testing from May 2020, but the number of tests
performed in May and June 2020 was substantially lower than in May and June 2019.
While testing has decreased overall during 2020, the proportion of bacterial STI and HIV
tests accessed via internet services has increased substantially since April 2020
(Figures 7 and 8; please see Appendix Figures 6 to 8 for information on individual STIs).
The shift to online service provision was also apparent through the National HIV and
Syphilis Self-Sampling Service, an online service jointly commissioned by PHE and local
authorities. HIV testing activity was highest during PHE-funded periods in January and
February 2019 (National HIV Testing Week) and June and July 2020 (Breaking the
Chain [vi]). Between January and August 2020, PHE tested just under 6,000 HIV and
syphilis self-sampling kits to support the testing campaign (Appendix Table 1). Overall, a
higher number of HIV tests were performed by the self-sampling service between
January and August 2020 compared to the same period in 2019 (14,872 vs 13,064)
(Appendix Figure 9). Whilst some of the increase between 2019 and 2020 was directly
iv Data from routine specialist and non-specialist SHSs' returns to the GUMCAD STI Surveillance System and also,
for chlamydia only, routine non-specialist SHSs' returns the CTAD Chlamydia Surveillance System. SHSs include both
specialist (Level 3) and non-specialist (Level 1 and 2) SHSs. Further details on the levels of sexual healthcare
provision are provided in the Appendix and in the BASHH Standards for the Management of STIs (Appendix B).
v Chlamydia testing and diagnoses in 15 to 24 year olds are considered as part of the National Chlamydia Screening
Programme (NCSP) and discussed separately in this report. The NCSP provides opportunistic chlamydia screening to
sexually active young people aged 15 to 24 years with the aim of reducing the prevalence of associated sequelae and
increasing the detection of chlamydia infection.
vi 'Breaking the Chain: Time to Test' was a national campaign aiming to encourage people to test for HIV during the
COVID-19 public health measures in England in June 2020. Further details of the campaign are given in the
Discussion of this report.
11The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for sexually transmitted infections, HIV and viral hepatitis in England due to campaign activity, around a third of additional tests delivered were driven by a general increase in demand for online testing. Figure 7. Number of bacterial STI tests (excluding chlamydia
The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for
sexually transmitted infections, HIV and viral hepatitis in England
Figure 8. Number of HIV tests, and proportion accessed via internet services, at
sexual health services in England, January 2019 to June 2020
2019 2020
2019 (all SHS) % Internet tests 2019
160,000 % Internet tests 2020 100%
140,000 90%
Percentage of tests
80%
120,000
Number of tests
70%
100,000 60%
80,000 50%
60,000 40%
30%
40,000
20%
20,000 10%
0 0%
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Month
The bars compare data from SHSs which had complete data reported for both January to June in 2019 and January
to June in 2020. The dotted line represents the total number of HIV tests in SHSs reported in each month in 2019.
Trends in the number of STI and HIV tests were similar across different age groups,
gender and sexual risk groups, ethnic groups and deprivation levels. However,
compared to January to March 2020, between April and June 2020 a higher proportion
of STI tests [viii] were accessed by people aged 25 to 34 years (51% vs 47%) and a
lower proportion by those in all other age groups (≤1% difference in each group). Over
the same period, a lower proportion of STI tests were accessed by heterosexual men
(26% vs 32%) and a higher proportion were accessed by MSM (19% vs 14%) (Appendix
Figures 10 to 14). For HIV tests, between April and June 2020, a lower proportion were
accessed by people aged 15 to 19 (7% vs 9%) and 20 to 24 years (25% vs 26%) and by
heterosexuals (men 25% vs 33%; women 49% vs 52%), than between January and
March 2020 (Appendix Figures 15 to 19). Over the same period, a higher proportion of
HIV tests were accessed by people aged 25 to 34 years (43% vs 39%) and by MSM
(24% vs 15%) than between January and March 2020.
viii Excluding chlamydia tests in ≤25 year olds. Chlamydia testing and diagnoses in 15 to 24 year olds are considered
as part of the National Chlamydia Screening Programme (NCSP) and discussed separately in this report.
13The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for
sexually transmitted infections, HIV and viral hepatitis in England
Between January and June 2020, the number of chlamydia tests carried out in 15 to 24
year olds through the NCSP was 29% lower than in the same period in 2019. There was
a steep downward trend from January to April 2020, followed by a slight recovery in May
and June, however, the number of tests reported in June 2020 was 37% lower than in
June 2019. Between January and April 2020, the reduction in chlamydia testing was
greater among specialist SHSs (85%) than in non-specialist SHSs (56%), largely due to
the higher proportion of internet-delivered tests offered (Figures 9 and 10) [ix].
Figure 9: Number of chlamydia tests in 15 to 24 year olds at sexual health services
in England, January 2019 to June 2020
Non-specialist SHS (2019) Specialist SHS (2019)
Non-specialist SHS (2020) Specialist SHS (2020)
140,000 all SHS (2019)
120,000
100,000
Number of tests
80,000
60,000
40,000
20,000
0
2019
2020
2019
2020
2019
2020
2019
2020
2019
2020
2019
2020
2019
2020
2019
2020
2019
2020
2019
2020
2019
2020
2019
2020
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Month and year
The bars compare data from SHSs (specialist SHSs) and chlamydia testing laboratories (non-specialist SHSs) with
complete data reported for both January to June in 2019 and January to June in 2020. The symbols represent the
total number of tests in SHSs reported in each month in 2019.
ix Specialist (Level 3) SHSs refers to genitourinary medicine (GUM) and integrated GUM/sexual and reproductive
health (SRH) services. Non-specialist (Level 1 and 2) SHSs refers to Sexual and Reproductive Health (SRH) services,
young people’s services, internet services, termination of pregnancy services, pharmacies, outreach, general practice,
and other community-based settings.
14The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for
sexually transmitted infections, HIV and viral hepatitis in England
Figure 10: Proportion of chlamydia tests in 15 to 24 year olds by testing service
type, January 2019 to June 2020
2019: Specialist SHS SRH GP Internet Other
2020: Specialist SHS SRH GP Internet Other
100%
90%
80%
Percentage of tests
70%
60%
50%
40%
30%
20%
10%
0%
2019
2020
2019
2020
2019
2020
2019
2020
2019
2020
2019
2020
2019
2020
2019
2020
2019
2020
2019
2020
2019
2020
2019
2020
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Month and year
The bars compare data from SHSs (specialist SHSs) and chlamydia testing laboratories (non-specialist SHSs) with
complete data reported for both January to June in 2019 and January to June in 2020. SRH: Sexual and Reproductive
Health Services. GP: General Practice. Other includes termination of pregnancy services, pharmacies and all other
community-based settings.
Testing for HAV, HBV and HCV
PHE’s sentinel surveillance of blood borne virus testing (SSBBV) captures testing for
HAV, HBV, HCV and HIV, from up to 23 participating laboratories in England,
representing approximately 40% of the population. Frontline testing for 2019 was
reported by 19 laboratories for HBV and HCV and 18 laboratories for HAV. The data
presented for 2020 includes only 17 laboratories for HBV and HCV and 16 laboratories
for HAV. Data from one London laboratory has yet to be received as data collection
requires a site visit, which has not been possible due to COVID-19 restrictions.
Between January and June 2020, there was a 24% reduction in HAV IgM tests (which
indicate the presence of acute infection) reported to SSBBV compared to the same
period in 2019 (18,429 vs 24,133 total tests) (Figure 11). Between January and June
2020, there was a 31% reduction in HBV surface antigen (HBsAg) tests (which indicate
15The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for
sexually transmitted infections, HIV and viral hepatitis in England
current infection) [x] reported to SSBBV compared to the same period in 2019 (235,858
vs 341,404) (Figure 12). Between January and June 2020, there was a 38% reduction in
HCV antibody (anti-HCV) tests (which indicate if the person has ever been infected) [xi]
reported compared to the same period in 2019 (161,148 vs 260,416) (Figure 13).
Between January and April 2020, the number of tests declined by 62% for HAV IgM
(from 4,422 to 1,672), 61% for HBsAg (from 59,042 to 22,824) and 74% for anti-HCV
(from 44,228 to 11,607). There was an increase in testing from May 2020, but the
number of tests performed in May and June 2020 remained substantially lower than in
May and June 2019. Testing in June 2020 compared to January 2020 was 36% lower
(2,819 tests in June), 47% lower (31,242 tests in June) and 55% lower (19,761 tests in
June) for HAV, HBV and HCV respectively.
Figure 11: Number of hepatitis A virus (HAV) tests, January 2019 to June 2020
x Presence of HBsAg indicates current infection but does not on its own indicate acute infection; the vast majority of
HBsAg detected are in people with chronic persistent infection which does not tell us when the infection was acquired.
xi Presence of anti-HCV indicates the person has "ever" been infected but does not on its own indicate current
infection (HCV RNA or Ag detection is also required).
16The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for
sexually transmitted infections, HIV and viral hepatitis in England
Figure 12: Number of hepatitis B virus (HBV) tests, January 2019 to June 2020
Figure 13: Number of hepatitis C virus (HCV) tests, January 2019 to June 2020
17The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for
sexually transmitted infections, HIV and viral hepatitis in England
Declines in HAV, HBV and HCV testing were seen across age groups and genders
between January and April 2020. The largest relative declines in HBV and HCV testing
between January and April 2020 were in drug services, SHSs, general practices (GPs)
and prisons (Appendix Figures 20 and 21). Testing in drug services saw the smallest
relative recovery between April and June 2020 for both HBV and HCV.
Between January 2020 and April 2020, the number of HCV tests in drug services
declined by 98% (from 3,175 to 62) and by 80% (from 4,386 to 879) in prisons.
Compared to January 2020, HCV testing in June remained 95% lower (170 tests in
June) in drug services, and 61% lower (1,694 tests in June) in prisons (Figure 14).
Figure 14: Number of hepatitis C virus (HCV) tests in drug services and prisons,
January 2019 to June 2020
18The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for
sexually transmitted infections, HIV and viral hepatitis in England
Diagnoses and proportion of people tested
that are positive
HIV and STI diagnoses and positivity
As with consultations and testing at SHSs, there was an initial downward trend in the
number of HIV and STI diagnoses from January 2020, with the lowest number of
diagnoses reported in April and May respectively.
Comparing data from SHSs with complete data reported between January and June in
2019 and 2020, the number of gonorrhoea diagnoses fell by 18% (Figure 15). The
number of gonorrhoea diagnoses declined by 58% between January and May 2020 and
despite a slight increase in June 2020, the number of diagnoses was 31% lower than in
June 2019.
For HIV, across SHSs with complete reporting, the number of diagnoses between
January and June 2020 was 21% lower than in the same period in 2019 (Figure 16).
There was slight increase in May and June 2020, however, the number of HIV
diagnoses was 11% lower than in June 2019.
Similar trends were observed for other STIs (Appendix Figures 22 to 26).
While HIV and STI diagnoses overall have declined during 2020, the proportion of
diagnoses made via internet services has increased substantially since April 2020
(Figures 15 and 16). For gonorrhoea, there was a two-fold increase in the proportion of
diagnoses made via internet services; 30% between April and June 2020 compared to
14% between January and March 2020.
19The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for
sexually transmitted infections, HIV and viral hepatitis in England
Figure 15: Number of gonorrhoea diagnoses at sexual health services and
proportion diagnosed via internet services in England, January 2019 to June 2020
2019 2020
2019 (all SHS) % Internet consultations 2019
% Internet consultations 2020
7,000 100%
Number of diagnoses
Percentage of diagnoses
6,000
80%
5,000
4,000 60%
3,000 40%
2,000
20%
1,000
0 0%
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Month
The bars compare data from SHSs which had complete data reported for both January to June in 2019 and January
to June in 2020. The dotted line represents the total number of gonorrhoea diagnoses reported in each month in 2019.
Figure 16: Number of new HIV diagnoses at sexual health services in England,
January 2019 to June 2020
2019 2020 2019 (all SHS)
250
Number of diagnoses
200
150
100
50
0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Month
The bars compare data from SHSs which had complete data reported for both January to June in 2019 and January
to June in 2020. The dotted line represents the total number of HIV diagnoses reported in each month in 2019.
20The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for
sexually transmitted infections, HIV and viral hepatitis in England
Between January and February 2020, the proportion of bacterial STI tests (excluding
blood tests) that were positive (test positivity) at SHSs was similar to January and
February 2019 (Figure 17). Bacterial STI test positivity increased during March and April
2020; 17% of tests in April 2020 were positive compared to 13% in April 2019. Test
positivity in May and June 2020 was similar to corresponding months in 2019. The
increase in bacterial STI positivity in March and April 2020 may reflect the prioritisation
of testing to those with symptoms [2].
HIV test positivity increased slightly between January and March 2020 (from 0.11% to
0.15%) and peaked in April 2020 (0.19%) (Figure 18). This initial increase was followed
by slight fluctuations in May and June, but positivity remained slightly higher than
equivalent months in 2019.
Figure 17: Bacterial STI test positivity at sexual health services in England,
January 2019 to June 2020
18% 2019 2020
16%
Bacterial STI positivity (%)
14%
12%
10%
8%
6%
4%
2%
0%
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Month
The bars compare data from SHSs which had complete data reported for both January to June in 2019 and January
to June in 2020. Bacterial STI positivity was calculated using all bacterial STI diagnoses including chlamydia,
gonorrhoea, Mycoplasma genitalium, Lymphogranuloma venereum (LGV), non-specific genital infection and pelvic
inflammatory disease, as a proportion of all screens where a chlamydia and gonorrhoea test was performed.
Infectious syphilis has been excluded as diagnosis usually requires a blood sample.
21The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for
sexually transmitted infections, HIV and viral hepatitis in England
Figure 18: HIV test positivity at sexual health services in England, January 2019 to
June 2020
0.25%
2019 2020
0.20%
HIV positivity (%)
0.15%
0.10%
0.05%
0.00%
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Month
HIV positivity was calculated using all new HIV diagnoses as a proportion of all HIV tests performed. The bars
compare data from SHSs which had complete data reported for both January to June in 2019 and January to June in
2020.
Shigella spp. are transmitted via the faecal-oral route and can cause severe dysentery.
In England, many cases are associated with travel to endemic areas. However, Shigella
spp. can also be transmitted through sexual contact. MSM are particularly at risk and
there has been an increase in sexual transmission in MSM within the last 10 years [3,4].
Laboratory confirmed diagnoses of Shigella spp are reported in near real-time through
SGSS from all NHS laboratories. These data do not include information on sexual
identity or behaviour, so diagnoses among adult men who have not reported foreign
travel are used as a proxy for sexual transmission in MSM [5].
Between January and April 2020, the number of Shigella spp diagnoses probably
associated with MSM decreased by 77% (from 75 to 17), followed by increases in May
and June (Figure 19). Between June and September, monthly Shigella spp. diagnoses
continued to occur but were lower than the equivalent months in 2019. The notification
of these acute infections, indicates continuing risks of transmission during the period of
lockdown and afterwards, but also a potential overall decline in the burden of shigellosis.
22The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for
sexually transmitted infections, HIV and viral hepatitis in England
Figure 19: Diagnoses of non-travel associated Shigella spp. in adult men in
England, January 2019 to June 2020
2019 2020
120
100
Number of diagnoses
80
60
40
20
0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Month
Hepatitis diagnoses and positivity
Laboratory confirmed positive reports of HAV, HBV and HCV are reported through
SGSS from all NHS laboratories and are deduplicated to identify new diagnoses.
Reported diagnoses of HAV refer to positive anti-HAV IgM tests, for HBV these refer to
positive HBsAg and/or anti-HBc IgM tests, and for HCV these refer to positive HCV RNA
and/or anti-HCV positive tests.
Like Shigella spp, HAV is transmitted by the faecal-oral route (including in MSM) and is
mainly associated with travel to endemic areas and / or food contamination. Therefore,
seasonality in HAV diagnoses and clusters are often observed following holiday periods
or availability of seasonal produce. HAV presents as an acute symptomatic infection and
so an HAV diagnosis indicates a new acquisition of infection. However, HBV and HCV
are blood-borne viruses and mainly manifest as asymptomatic chronic infections, so an
HBV or HCV diagnosis, in the absence of clinical features, is largely indicative of past
acquisition.
The number of different source laboratories reporting HAV diagnoses to SGSS fell by
38% between January and June 2020 (from 24 in January to 15 in June) before
increasing in July (18 in July, 25% decline from January to July). The number of different
source laboratories reporting HBV and HCV diagnoses to SGSS fell by 27% (from 78 in
January to 57 in April) and 54% (from 92 in January to 74 in April), respectively, and
remained at similar numbers between April and August. However, laboratories are only
23The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for
sexually transmitted infections, HIV and viral hepatitis in England
counted if they report new diagnoses to SGSS so caution is required in interpretation as
the decline may be a combination of underreporting as well as decreased diagnoses.
Between January and June 2020, there was a 37% reduction in new diagnoses of HAV
compared to the same period in 2019 (127 vs 203) (Figure 20). Between January and
June 2020, the number of new diagnoses of HAV declined by 82% (from 33 to 6) [xii].
Figure 20: Number of new hepatitis A (HAV) diagnoses in England, January 2019
to June 2020
Between January and August 2020 there was a 34% reduction in new diagnoses of HBV
reported compared to the same period in 2019 (3,754 vs 5,719) (Figure 21). For HCV,
there was a 45% reduction in new diagnoses compared to the same period in 2019
(6,050 vs 11,005) (Figure 22). Between January and April 2020, HBV and HCV new
diagnoses declined by 75% (from 873 to 218) and 85% (from 1,466 to 227),
respectively.
xii New HAV diagnoses from SGSS are reconciled with the results of confirmatory testing undertaken at the PHE
Virus Reference Department (VRD) in Colindale in order to remove false positive HAV IgM results that can occur due
to cross-reactivity and lower specificity of the test in some people. It is not possible to interpret data after June 2020
as reconciliation with confirmatory testing by the reference laboratory have not been completed; usually the numbers
of new diagnoses decline as false positives are removed.
24The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for
sexually transmitted infections, HIV and viral hepatitis in England
Unlike new HAV diagnoses which continued to decline until June, the initial decline in
new HBV and HCV diagnoses was followed by an increase in new diagnoses between
April and July 2020, however, both new HBV and HCV diagnoses in July were 56%
lower (385 and 642 in July, respectively) than in January 2020. New diagnoses of HBV
and HCV declined slightly again between July and August 2020, but this may reflect
reporting delays. The number of new diagnoses each month of HAV, HBV and HCV
since March 2020 have remained lower than in the equivalent months in 2019.
The large relative declines in new HAV diagnoses between January and June 2020 and
in new HBV and HCV diagnoses between January 2020 and April 2020 were generally
seen in both men and women, across all age groups and regions, and, for HCV, across
all specialities and settings. There were, however, some notable exceptions; the relative
decline in new HCV diagnoses between January and April 2020 was markedly greater in
drug services, and smaller in London and in people aged 65 years and over. The relative
decline in new HBV diagnoses between January and April 2020 was slightly greater in
men than women, in Yorkshire and Humber, the East Midlands and the North West, and
smaller in individuals aged 65 years and over.
Figure 21: Number of new hepatitis B (HBV) diagnoses in England, January 2019
to June 2020
25The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for
sexually transmitted infections, HIV and viral hepatitis in England
Figure 22: Number of new hepatitis C (HCV) diagnoses in England, January 2019
to June 2020
The proportion of individuals testing positive (test positivity) is calculated from positive
and negative tests reported through PHE’s sentinel surveillance of blood borne virus
testing (SSBBV). Positivity is useful particularly for chronic infections such as HBV and
HCV as an indication of whether testing and diagnostic services are reaching higher risk
populations.
Between January and March 2020, test positivity increased (from 0.8% in January to
0.9% in March) for HBV (Figure 23) and remained stable for HCV antibody (around
2.8%) (Figure 24). Positivity fell in April for both HBV and HCV, by 44% (to 0.4% in April)
and 51% (to 1.4% in April), respectively, when compared to January 2020.
Test positivity for HBV and HCV increased between April and June 2020 but was lower
than in the same period in 2019. Compared to January 2020, positivity in June 2020 was
34% lower (0.5% positivity in June) for HBV and 40% lower (1.7% positivity in June) for
HCV. The drop in positivity during April to June 2020 compared to January to March
2020 and the equivalent period in 2019 may indicate that people at lower risk were
accessing service provider venue-based testing, whilst those at greatest need were not.
26The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for
sexually transmitted infections, HIV and viral hepatitis in England
Figure 23: Hepatitis B virus (HBV) positivity and number of people tested in
England, January 2019 to June 2020
Figure 24: Hepatitis C virus (HCV) positivity and number of people tested in
England, January 2019 to June 2020
27The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for
sexually transmitted infections, HIV and viral hepatitis in England
Declines in HBV positivity from April 2020 were observed across all ethnic groups
although a substantial proportion of cases had unreported ethnicity (Appendix Figure
27).
The decrease in HCV positivity was not uniform across test settings. Prisons and drug
services test higher risk groups, ie people who inject drugs. HCV positivity among those
tested in drug services fell by 56% between January and April 2020 (from 22.2% to
9.8%) before increasing in June to levels comparable to June 2019 (17.1% in June
2020) (Figure 25). By contrast, HCV positivity among those tested in prisons remained
relatively stable between January and June 2020 (fluctuating between 3.7% and 4.8%)
and was comparable to the same period in 2019.
While positivity should be interpreted with caution given the drop in the numbers tested
in drug services from April to June 2020, the observation that positivity was stable in
prison services but fell in drug services may reflect sustained provision of testing in the
closed prison environment, whereas drug services in the community may have been
less accessible to those at highest risk.
Figure 25: Hepatitis C virus (HCV) people tested and positivity in England in drug
services and prisons, January 2019 to June 2020
28The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for
sexually transmitted infections, HIV and viral hepatitis in England
Treatment and care
Patient HCV treatment episodes are reported to PHE through NHS England’s Hepatitis
C Patient Registry and Treatment Outcome System. Data for the most recent months
are subject to change as a result of delayed reporting.
Between January and August 2020, there was a 30% reduction in treatment initiations
reported compared to the same period in 2019 (5,013 vs 7,136) (Figure 26). Between
January and April 2020, reported treatment initiations declined by 68% (from 991 to
322). The number of treatment initiations increased from April to June, however,
treatment initiations in June 2020 remained 41% lower (586 in June) than in January
2020. The number of reported monthly treatment initiations since April 2020 has
remained lower compared to the same period in 2019. Although declines in HCV tests
and diagnoses began in February 2020, large falls in HCV treatment initiations did not
begin until April.
The decline in treatment initiations occurred across age groups, for men and women, for
people reporting and not reporting injecting drug use, and across sources of treatment
referral. Sustained treatment initiations in March 2020 likely reflect continued referrals
from drug services and an increase in prison referrals between January and March 2020
(Appendix Figure 28). The rebound in treatment initiations in June 2020 was driven by
referrals from all settings including primary and secondary care.
Figure 26: Hepatitis C (HCV) treatment initiations in England, January 2019 to
August 2020
29The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for
sexually transmitted infections, HIV and viral hepatitis in England
Evidence from service user and community
surveys
People who inject drugs
Preliminary data from the PHE Unlinked Anonymous Monitoring (UAM) Survey of
People Who Inject Drugs (PWID) indicate that the COVID-19 response has affected
access to essential services for PWID in England. Just over a third (61/166) of PWID
participants reported that in 2020 drug and alcohol services were more difficult to access
than in 2019, with 22% (30/136) reporting difficulties accessing HIV and/or hepatitis
testing and accessing equipment for safely using and/or injecting drugs (29%; 40/137).
Eleven per cent (10/87) of participating PWID reported some form of HCV treatment
disruption. More detailed analysis from the survey will be published in 2021.
Men who have sex with men
An online community-based survey conducted through the National Institute of Health
Research Health Protection Research Unit in Blood Borne and Sexually Transmitted
Infections suggested that, although there had been a decline, there was ongoing risk of
STI and HIV acquisition and need of healthcare among MSM, including HIV pre-
exposure prophylaxis (PrEP), during nationwide restriction measures ('lockdown')
implemented in response to the COVID-19 pandemic [xiii]. The survey found that during
lockdown beginning in mid-March, 47% (447/956) of MSM reported one or more new
sexual partners and 20% (194/956) reported condomless sex with multiple partners.
This compared to 71% (1127/1585) and 31% (559/1812), respectively, from the same
period in the equivalent survey conducted during 2017. Of the MSM reporting
condomless sex with multiple partners during lockdown, 57% had not accessed STI
testing at time of survey completion. The full findings from this study will be published in
due course.
xiii The research was funded by the National Institute for Health Research Health Protection Research Unit (NIHR
HPRU) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public
Health England (PHE). The views expressed are those of the authors and not necessarily those of the NIHR, the
Department of Health and Social Care or Public Health England. We acknowledge members of the NIHR HPRU in
BBSTI Steering Committee: Professor Caroline Sabin (HPRU Director), Dr John Saunders (PHE Lead), Professor
Catherine Mercer, Professor Gwenda Hughes, Professor Greta Raita, Dr Ruth Simmons, Professor William
Rosenberg, Dr Tamyo Mbisa, Professor Rosalind Raine, Dr Sema Mandal, Dr Rosamund Yu, Dr Samreen Ijaz, Dr
Fabiana Lorencatto, Dr Rachel Hunter, Dr Kirsty Foster and Dr Mamooma Tahir. We are grateful to Dr Alison Howarth
at University College London who led the MSM survey and performed the analyses presented here.
30The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for
sexually transmitted infections, HIV and viral hepatitis in England
Discussion
National surveillance data from multiple settings show a decline since March 2020 in
consultations at SHSs and HIV specialised services; tests and diagnoses for STIs, HIV
and viral hepatitis; vaccinations of MSM; and HCV treatment initiations. These changes
follow the implementation of nationwide social and physical distancing measures,
including the emphasis on staying at home, and a reduction in capacity and throughput
at services. The greatest fall was seen in services which cannot be provided remotely,
such as vaccination and HCV testing. Test positivity at SHSs was also highest in April
2020, likely due to the prioritisation of services for those at higher risk, who are clinically
vulnerable, or who have STI-related symptoms [2].
These analyses provide strong evidence that the COVID-19 pandemic response,
including social and physical distancing measures, led to a re-prioritisation and
disruption in provision of, and patient access to, health services for HIV, STIs and
hepatitis. The findings are supported by surveys from the British Association for Sexual
Health and HIV [6], the British HIV Association, the PHE UAM survey of PWID [7],
PHE/HCV Action survey of HCV peer supporters [8], as well as anecdotal reports from
hepatitis treatment providers, drug and alcohol and prison services that indicated
significant disruption to services and re-deployment of staff. There have also been
reports of disruption to supplies of laboratory consumables due to increased demand
which have impacted on testing service capacity. In addition, there has likely been some
reduction in infections and service need following compliance with social distancing
measures, resulting in fewer opportunities for travelling and meeting sexual partners,
and reduced risk of exposure; for example, some early evidence from an NIHR HPRU
study on MSM reported here suggests there was a decline in risk behaviours during this
period that may have contributed to the fall in diagnoses.
Innovations in service delivery have happened at pace and, from April 2020, there was a
marked shift towards remote and outreach service provision to maintain access during
the COVID-19 pandemic. Harm reduction services for PWID and HCV testing and
treatment largely shifted to a community outreach model of provision, through peer
supporters, outreach nurses and postal delivery [8]. Our analyses also show that SHSs
and HIV specialised services increased provision of online and tele-consultations and
self-sampling kits, with 44% of SHS consultations delivered via the internet between
April and June.
The decline in diagnoses reported results from a combination of reduced testing,
delayed reporting and a reduction in infections. The full impact of the COVID-19
measures on infection transmission and longer-term health outcomes will take time to
emerge. A modest rebound in HIV, STIs and hepatitis diagnoses and HCV treatment
initiations since June might indicate a recovery in service provision and demand, the
latter also potentially influenced by changes in risk perception and behaviour. However,
31The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for
sexually transmitted infections, HIV and viral hepatitis in England
the respective numbers of consultations, vaccinations, tests, diagnoses, and treatment
initiations in the summer were considerably lower compared to the corresponding
months in 2019. Evidence of recovery in HCV treatment initiation is reassuring, but
further evaluation of treatment outcomes is needed.
Impact on health inequalities
Internet, telephone and community outreach initiatives have the potential to increase
access to hepatitis, STI and HIV testing, but care is required to ensure that services
remain widely accessible, particularly to underserved populations (eg certain Black,
Asian, and minority ethnic groups, migrants, PWID, sex workers, homeless persons,
prisoners) who are disproportionately affected by hepatitis or have greater sexual health
needs.
Our findings suggest that there has been a shift in the demographic distribution of
people accessing HIV, STI and viral hepatitis testing during 2020 and there are early
indications that access to harm reduction and BBV testing services for PWID have been
adversely affected. This is concerning given existing inequalities in sexual health and the
disproportionate burden of viral hepatitis on marginalised communities.
Our analyses show that, among those testing for STIs and HIV, heterosexuals and,
particularly in the case of HIV, teenagers, have been under-represented since April 2020
compared to January to March 2020. Further investigations are needed to explore these
changes, but there is evidence that young people, the age group with the highest burden
of STIs, may experience greater difficulty in finding, accessing and engaging with
relevant online sexual health information [9]. Among those accessing drug services, the
decline in HCV positivity since March 2020 among those tested suggests a shift in
access away from those at greatest need of testing and linkage to HCV care through
traditional services, although the full impact of community outreach models on mitigating
this is yet to be fully understood.
There is a critical need to evaluate the impact of changes in service delivery on health
inequalities, particularly as some infections predominantly affect socially disadvantaged
and excluded groups, where disparities in health outcomes already exist.
Mitigations to address the impact of COVID-19
Several initiatives were launched, by PHE and our partners, to counter the detrimental
impact of COVID-19 on the control of STIs, on elimination goals for HIV and viral
hepatitis, and in tackling inequalities. Some of these campaigns and innovation in
service access and delivery are described below:
32The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for
sexually transmitted infections, HIV and viral hepatitis in England
• in April 2020, PHE contributed to the publication of a set of recommendations from
the Association of the Directors of Public Health on the prioritisation of sexual and
reproductive health services, including the protection of essential services, and the
changes in delivery likely required due to the COVID-19 pandemic
• 'Breaking the Chain: Time to Test' was a national campaign founded by 56 Dean
Street to encourage people to test for HIV in June 2020. The campaign sought to
identify people with undiagnosed HIV so they could start treatment early, improve
their health, and prevent them from passing on HIV. Through the National HIV and
Syphilis Sampling Service, PHE provided up to 10,000 free HIV self-sampling kits,
including syphilis opt-out testing over June 2020. PHE's HIV Prevention England
programme (delivered by Terrence Higgins Trust and local partners) promoted the
campaign through 'It Starts With Me'. Promotion was focused on black African people
and gay and bisexual men
• PHE has worked with a range of partners including Central North West London
(CNWL) NHS Trust to develop a suite of resources for use by local providers and
commissioners to help them understand the impact of service changes and inform
recovery and renewal plans. The suite of resources include specialist sexual health
services rapid evaluation tool, sample service user and healthcare staff survey
questionnaires. The resources are available on the Sexual Health, Reproductive
Health and HIV K-Hub; BASHH website and FSRH website
• PHE established a National Framework for e-Sexual and Reproductive Healthcare in
August 2020 to support local authority commissioners in rapidly providing an internet
service for HIV/STI self-sampling, BBV testing, condom provision and a range of
contraception options
• following initial suspension of NHS hepatology outpatient clinics, HCV Operational
Delivery Networks explored new ways of providing services through remote clinics,
telephone consultations, BBV self sampling, and home visits for fibroscans [8]
• outreach HCV testing to people temporarily housed in hostels and hotels as part of
the government’s “everybody in” policy was expanded in 2020 to reach PWID and
experiencing homelessness who are at particularly high risk of HCV infection [8]
• PHE undertook a rapid evidence review of harm reduction interventions and
messaging for PWID during pandemic events to support policy makers,
commissioners and providers to respond to the needs of this marginalised group [10],
which has been shared with commissioners and providers of harm reduction services
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